Residential Assisted Living Facility Training (RALF)
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1 Residential Assisted Living Facility Training (RALF)
2 Overview At you will find: Trading Partner Account (TPA) registration and sign-in Prior Authorization Patient Roster o Eligibility o Claim Submission Copy Last Claim Claim Status Remittance Advice 2
3 Navigating the Secure Portal 3
4 TPA Registration 4
5 Navigating the Secure Portal 5
6 Prior Authorization 6
7 Authorization Status 7
8 Authorization Status Search 8
9 Authorization Status Detail 9
10 Patient Roster 10
11 Patient Roster Add New Member 11
12 Patient Roster Add New Member 12
13 Patient Roster Verify Eligibility 13
14 Patient Roster Verify Eligibility 14
15 Eligibility 15
16 Eligibility A&D Waiver Coverage 16
17 Eligibility DD Waiver Coverage 17
18 Eligibility Enhanced Coverage 18
19 Eligibility MMCP with A&D Waiver Coverage 19
20 Claim Submission 20
21 Patient Roster Submit Claim 21
22 Claim Submission Professional Claim (1500) 22
23 Claim Submission Confirmation The claim ID displays in the upper left corner of the confirmation page. Select the Claim View link to see the detail of claim. Select the Edit Claim button to modify this claim. (For example, if you realize the dates of service are incorrect, you can immediately fix the claim.) Select the New Claim option to enter a new claim. Select Adjudicate Claim to process the claim for payment or identify any outstanding edits. 23
24 Claim Submission Copy Last Claim Copy Last Claim will copy over some information from the last claim submitted for this member. However, it is important to review all fields to either add additional or correct pre-populated information. 24
25 Claim Status 25
26 Claim Status Overview 26
27 Claim Status Search 27
28 Remittance Advice 28
29 Remittance Advice 29
30 Remittance Advice Banner Page 30
31 Remittance Advice Claim Detail 31
32 Remittance Advice Claim Detail 32
33 Remittance Advice Summary 33
34 Important Information As a reminder, please keep your contact information (including your mailing address) up to date at all times. This will ensure you receive important information Molina may need to communicate. 34
35 Did You Know?
36 Announcements 36
37 Information Releases 37
38 Provider Handbook 38
39 Provider Handbook 39
40 Fee Schedules 40
41 Fee Schedules 41
42 MedicAide Newsletters 42
43 MedicAide Newsletters 43
44 User Guides 44
45 Training 45
46 Idaho Medicaid Training Center 46
47 Training Opportunities Monthly WebEx Trainings o o Available to all providers Calendar is located at Regional Workshops o o Yearly Information will be posted to Individual Training or Questions o Contact your local Provider Relations Consultant 47
48 Enrollment and Maintenance
49 Enrollment/Maintenance Be sure to keep your information up to date. o o o o o Current contact Mailing/W9/physical/ addresses Adding and terming rendering providers Adding and terming service locations Change of ownership 49
50 Enrollment and Maintenance 50
51 Enrollment and Maintenance Forms 51
52 Provider Maintenance 52
53 Provider Maintenance Maintenance is required when any information changes: Mailing/W9/physical/ addresses Add, term, update service locations Rendering or service provider changes Name changes Change in ownership Note: Contact updates are made through Maintenance Demographic. 53
54 Tips Use current forms Complete all sections of the form use N/A when appropriate Utilize the Provider Enrollment Requirements document in the Provider Handbook for type and specialty information, as well as additional requirements New W9 for 1099 changes W9 name and tax ID must match IRS records Update provider credentials (licenses, certifications, insurance, etc.) 54
55 Tips Provider Maintenance The Idaho Molina Medicaid website ( has the following resources: Provider Enrollment - Verifying Enrollment Application Status Provider Handbook User Guides Contact Molina at 1 (866) or idproviderenrollment@molinahealthcare.com for assistance with enrollment or maintenance 55
56 Provider Relations Consultants Region 1 and the state of Washington 1 (208) Region.1@MolinaHealthCare.com Region 2 and the state of Montana 1 (208) Region.2@MolinaHealthCare.com Region 3 and the state of Oregon 1 (208) Region.3@MolinaHealthCare.com Region 4 and all other states 1 (208) Region.4@MolinaHealthCare.com Region 5 and the state of Nevada 1 (208) Region.5@MolinaHealthCare.com Region 6 and the state of Utah 1 (208) Region.6@MolinaHealthCare.com Region 7 and the state of Wyoming 1 (208) Region.7@MolinaHealthCare.com 56
57 Thank you for attending our Residential Assisted Living Facility Training. Please take a few minutes to complete the evaluation. This provides us with valuable information for future trainings.
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